I went to the Medicaid Expansion hearing on January 15. I came away with the impression that Medicaid reform should be the order of the day rather than expanded.
The proponents of the bill are asking that single adults between the ages of 19 and 64 who are at 138% and below of the poverty level be allowed to enroll in MaineCare. Many who testified were either unable to afford insurance due to income or had lost employer coverage due to changes in the health care laws. There were those who had concerns about being able to obtain necessary medications for health issues such as Diabetes.
It became apparent to me that these individuals, otherwise healthy adults who could take care of themselves are not really proper candidates for Medicaid. Medicaid was/is supposed to be for those who cannot help themselves and are without any visible means of support. I know there are those added to the coverage such as children but asking the State to provide insurance to individuals who are, despite income minor restrictions, capable of taking care of themselves is a big leap.
With a Medicaid reimbursement rate at .43 cents on the dollar, medical care providers often complain they cannot cover costs for services. The cost to taxpayers for MainCare recipients, whether federally funded or not, is at $487 per person per month in 2010 dollars. Surely an exchange rate premium would be cheaper than this and provide a better reimbursement rate to medical providers. I should also be mentioned that the federal government only reimburses 100% for those up to 133% and that only for specified services. Go to www.medicaid.gov. You can see what the Federal Government considers reimbursable at 1005 and according to them prescription medication is an option, paid for by the state.
I question why the ACA and Federal government did not make provisions for these individuals on the exchange rather than ask the States to increase their Medicaid enrollments. If individuals and families are getting subsidies on the exchange why not pay the premiums for these individuals? Wouldn't the individuals, hospitals and medical professionals be better served by such an arrangement?
One could extend this idea and reduce the number of individuals on MaineCare by adding them to the exchange, say the low income children and their parents enrolled already. This would mean the loss of federal dollars to the State of Maine but since those are tied to Medicaid reimbursements and on terms Maine would be better served in the reduction of program costs. The government could then devote more of the State's resources to other key areas of government such as education and roads. Federal money would still enter the state via payments for services and jobs created as a result and at lower cost to the Maine taxpayer.